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    Old 09-06-2004, 03:00 PM   #1
    TATS
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    advice on conversion Shore if possible?

    Hi, Looks Like The Strom Is Almost Gone?but I Just Heard Ivan The Terrible Is Coming?back To My Question I Take 220mg Of Pain Meds ,ie;roxi Ir,morph.er..........my Liver Is Bad And My Doc Has Advised Me To Go To The Patch.check My Other Thread From Yesterday It May Help Clear Up My Babble?living In Fla .is Hot And I Sweat,plus I Use Hydro Therapy Daily.can The Patch Come Off And Be Put Back On?is It Hard To Work With?i'm Thinking 75 Mg And Loipop For Break Through?this Is Only If Gov.well Take My Civilian Doc Script And Sign Off On It Ie.,agree?the Pharmacy Said They Only Give The Med To Cancer Patients But Would Make The Exception In My Case?this Revolves Around Jansen Pharm Says I Make To Much ,however I'm A Disabled Vet And 550 For A Month Of Patches Is Mind Numbing.no Kidding If The Gov. Does'nt Help It'll Come Down To House, Meds,then Food Or Bills?this Is A Drag And I'm Falling Apart.if Any One Can Give Me Some Direction On The Plus And Minuses Of The Patch That Would Help Me ?am I Going In The Right Direction With All My Other Problems?thanks For Every Thing ...........tats

     
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    Old 09-06-2004, 06:42 PM   #2
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    Re: advice on conversion Shore if possible?

    Your pharmacy said they only give the patch to pain patients? That's not correct. Most pharmacies will give them to patients who a prescription from pain management doctors as well. And I didn't realize they cost so much wow!

    My doctor offered to prescribe them for me last week but I can't use them because I am allergic to the glue and it peels my skin off, so overall it wasn't an option.

     
    Old 09-07-2004, 06:19 AM   #3
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    Re: advice on conversion Shore if possible?

    Hey Tats, When the Fentanyl patch first came out "Duragesic", it was aproved for cancer use only too, I have a friend that was involved in the clinical trials for non malignant use of the patch and it's been used for Off brand purposes ever since"meaning non malignant pain".

    Actiq, the faster acting fentanyl pop is still aproved by the FDA for cancer use only but that doesn't mean your doc can not prescribe it for non cancer pain, He can prescribe any med he wants, But the FDA aproval for cancer pain only is the insurance companies way to refuse the expensive scripts, a 200mic pop runs about 8 bucks a piece and a 1600 mic pop almost 20 bucks a piece, You also have to remember that there is nothing stronger that can be used for BT or any pain pain. Fentanyl is as strong s you can find outside of injectable meds in the hospital.

    Your total daily dose doesn't really fit the profile for needing the strongest med available, but if your doc wants to try....

    BT meds are usually based on a % of your base med, If you take 80 mgs of OxyC twice a day usually 20-30 of that 80 is sufficient BT strength, 30mgs of MSIR or Roxicodone should suffice without putting you in law law land. The formula is 20-30% of the BID dose of your base med.

    If your dose is 60 mgs of MSContin 3 times a day, your would convert that into 2 daily doses of 90 mgs of MSC twice aday and take 20-30% of that number, 30mgs of MSIR should suffice or 30mgs fo roxi would be an even greater percentage, If you need such great percentages of BT meds perhaps your base dose is just too low.

    Actiq is a whole different story as far as the Big gun, There is nothing stronger than the 1600 mic pop, I would imagine the other poster started at 200mic, then needed 400 then used 2 400 got to 800, and so on to the point of only the absolute strongest oral med on the market is needed for BT pain.

    I see peoples BT doses of actiq well exceed their daily use of LA meds which really doesn't make sense, why bother with a piddly 200 mgs of LA morphine when your getting the equivelent to several thousand mgs of morphine in the way of aqtiq. It also makes wonder if the docs prescribing really know how strong a 1600 mic pop is. There aren't many people that can take 1000mgs of MSIR in a single dose on top of their base med but I see it with aqtiq when you have folks taking 3 or 4 1600mic pops a day, that's the equivelnt of over 5000mgs of MSIR a day. Your tolerance will skyrocket and treating pain in the future will that much harder. Thge only thing stronger would be to have 2 1600 mic pops in your mouth at the same time.

    Personally I have avoided it due to cost and just knowing there is something out there stronger should I ever need it. I've gotten buy with 2-3 30 mg MSIR or roxicodone when taking 600 mgs of Kadian or 150 mgs of meth as a base. 1 1600 mic pop would be more opiate than the entire 600 mgs of Kadioan I took per day. When you have folks using sevreal a day you reach huge numbers when convertng fentanyl back to aqtiq, If it's your last option, I can see the benefit, But there are other much less expensive options. 120 30mg MSIR cost me about 30 bucks, 120 4 mg dilaudid is 26, Versus 8-20 bucks a single dose of aqtiq.

    MY concern would be, what could they ever give me if I were injured or needed additional surgery when my tolerance is so high only 1600mics of Actiq relievs your pain. Norco and MSIR become tic tacs in relative comparison. Break your arm, go to the ER and see how much help Vicodin is?

    Fentanyl is also a NMDA receptor binder, oposite of blocking which methadone, dex and Nemanda do which can cause Hyperalgesia when it wears off, increased tolerance and decreases thresh-hold.

    your insurance may not go for a cancer med only. They can stand on that leg and win, so can a pharmacist, they don't have to fill if they are not comfy with the dose.

    As far as using the patch, no you can't remove and reatach, you will notice the transdermal material will be covered with tiny dry skin cells that block the transdermal material and all adhesive and abilty to transfer the med is lost.

    The only option I can think of is to ask Jansen for the bioclusive dressings, They are large 3X6 "roughly" adhesive patches that cover the entire Duragesic patch and twice as much skin all the way around, this should prevent water leakage and damage of the patch, you still shouldn't put that part of your body into a hot whirlpool or sauna as heat can cause faster release of meds. Other than the heat, using the Bioclusive covers should work.

    If you have never used them call jansen, tell them you have an adhesion problem, don't tell them your breaking out from the adhesive because they won't send you any adhesive patches if you tell them you having a reaction. But the first time you call they will likely recomend a method of cleaning your skin prior to application, If that doesn't work, wait a week and call back and expalin your still having problems. They will then send you the dressings at no charge.

    There is also a trick many docs use to promote adhesion. If you spray the area the patch is to be applied with a steroid based nasal sparay or inhaler for asthma, the steroids and other meds in the sprays and inhalers promote adhesion. ie spray caldicort on the area before aplying a new patch. But you can't remove and replace, you need to avoid high temp exposure, and humidity is bound to cause some adhesion problems, the bioclusive dressing should take care of adhesion problems, But the initial design of the patch was for cancer patients that were bed ridden, inactive and sedentary and this lifestyle is condusive to keeping a patch in place, a more active lifestyle will cause more adhesion problems but they can be dealt with.

    If using fentanyl, as a base or BT med I would highly recomend talking to your doc about adding a NMDA blocking agent like Nemanda or Dexalone to the mix to prolong the action, decrease tolerance and increase your threshold to pain and avoid hyperalgesia.
    Good luck, Dave

     
    Old 09-07-2004, 10:44 AM   #4
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    Re: advice on conversion Shore if possible?

    Hey Dave ,thanks For Coming Along And Hipping Me To The Facts.sorry To Read About The Problems Your Wife Is Having.by Chance Did You Read My Other Thread -bladder,back..........i'm In A Real Trick Bag.with L5 And S1 Being The Root Of the Problem ,do You Think Long Acting Meds Could Be Relaxing My muscles And Nerves So Much That I Need To Catheter My Self?twice A Day....i Know It Could Be Worse? My Life Has Done A 360 In The Last 2 Yrs.i Cant Do Any Of The Things I Use To. I Need To Figure Out This Bladder Thing.......this Is Messing With My Head,but Seriously Before The Patch Becomes Part Of My Life,do You Think It May Be Adding To My Problems?my Doc Likes The Idea Of The Patch For Its Delivery Method.all My Orgins Are Messed Up Probly Better To Avoid Them?thanks For All You Do And Take Care........will....

     
    Old 09-07-2004, 05:50 PM   #5
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    Re: advice on conversion Shore if possible?

    Hey Tats, I haven't checked the other thread to see if you list every med, But opiates are notorious for urinary retention, what your experiencing is the worst case scenario. Did you have any problems prior to the meds or at the beginning of an increase.

    IF you have an enlarged prostate that won't help either. My Brothers friend is a coronor, she said she's never done an autopsy on a man over 60 that didn't die of prostate cancer or have prostate cancer, She made it sound very much like it wasn't a matter of If but when. prostatitis can opiates are a bad combo. Other meds can cause problems. The nerve that really controls that function comes out of S2, the -pareneal nerve, did you break your tailbone lately or Is the problem with L5-S1 severe enough to be effecting those nerves.

    Sorry about more questions, when ewwwwwas your other thread, I wasn't on all weekend? The patch is a good idea because it means only one pass throug your system, It goes directly into your bloodstream, bypassing the first pass through the liver like with the pills. Even though opiates aren't particularly bad for the liver, any extra burden that can be avoided is worth it. It may make a difference in the urinatinon, morphine causes more smooth muscle problems, like UR and constipation than some of the others.

    Switching meds will hopefully make a huge difference, Let me know. You must have one large bladder only to eliminate twice a day.LOL It's probably not good to go that long but I don't think I would be in a hurry either.
    Take care, Dave

     
    Old 09-07-2004, 06:12 PM   #6
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    Re: advice on conversion Shore if possible?

    I too mentioned in his other post that taking the Morphine in particular was a cause of Urinary retention or urination problems and questioned why doctors had Tats on such a medication that would only compound his current situation.

     
    Old 09-07-2004, 08:00 PM   #7
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    Re: advice on conversion Shore if possible?

    HEY SHORE,ONCE AGAIN THANKS THE BACK INJURY WAS 2 YRS AGO,SAME WITH LEFT SIDE PAIN (BLADDER).the VA WANTED TO GIVE VD TEST AT FIRST........SO HERE I AM ,I'M IN A GENITOURIANRY SURGERY CLINIC THE DOC HAS #22FRENCH FLEXIBLE CYSTOSCOPE I'M NUMB THE NEXT THING I HEAR IS THE POSTIERIOR URETHA REVELEALED APPROXIMATELY 5 GRAMS OF OPEN PROSTATE TISSUE?NEVER HAD A CHANCE TO ASK WHAT THAT MEANS?IS THAT AN ENLARGED PROSTRATE?THERE WERE NO STONES OR TUMERS AND THE DOC SAID ITS THE BACK INJURY?IS IT POSSIBLE IVE HAD POSTRATE PROBLEMS BEFORE I INJURED MY BACK AND DIDNT CATCH IT TILL I GOT INJURED THUS REDIRECTING MY FOCAS?THANKS FOR HIPPING ME TO THE S2 SOMETIMES I 'LL BELEIVE ANY THING....IF IVE LEARNED ANY THING FROM THIS BOARD IT IS TO ASK .THANKS BRO AND TAKE CARE.... WILL...

     
    Old 09-08-2004, 12:28 PM   #8
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    Re: advice on conversion Shore if possible?

    Will, Get your prostate checked again. Have you had any follow up blood work. Funny you remeber the cystoscope so well. I remeber them well too. Had a french double J stent removed in the office once and stones and stents placed and removed a half dozen times.

    That's extremly abnormal about your prostate, and you could very likely had problems prior to the back inury especially if the VA is your primary care provider. The problem with the VA and other docs is the rigth hand doesn't know what the left hand is doing if anything at all. They should have done something about a very enlarged prostate, At least prescibed an antibiotic like Cipro, that's probably why you can't pee. I'll teach you the secret handshake for men that have to sit.LOL

    Gotta keep your sense of humor. But you need to be having blood work and PSA levels followed, they indicate how healthy your prostate is. The numbers followed and follow up care. I don't know how a problem that large wouldn't be atributed to your prostate. The eurethra passes through the prostate between the bladder and the out hole. Enlarged prostates causes stricture of the eurethra. I would bet my broken hardware that's the problem. But you realy don't want it.lol

    If you have the means to get outside the VA, I would hate to see you croak before they ever got around to looking a few pages back in your file. Lordy!!!

    I'm talkng way down the road, the croaking thing is a joke, you do need answers to how is this 5 grams of exposed material effecting you. It does sound like you have a little something going on like most older men. I've had problems since my late 20"s around the time my first back problems, But I have had that checked more than enough times to know when I have drinken too much coffee or am experincing UR.

    At this point you got me confused because it's not clearly one thing. I'm more inclined to believe it's prostate related. I'm not a doc but you really have to have it checked , however unpleaseant it may be.
    Good luck, Dave

     
    Old 09-10-2004, 10:40 AM   #9
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    Re: advice on conversion Shore if possible?

    I Just Lost Every Thing In Cyber Space ,this Is Getting To Be A Drag .shore Thanks,im Living On An Island Thats Got To Be Evacuated For The 3rd Time And I'm Stessed (addisons)out.iwent To The Va And Fired My Gp This Is Were My Problem Started.a Little Over A Year Ago I Went To Him In Pain (prostrate) He Gave Me A Vd Test Syph. I Told Him Sinse Back Injury Sex Was'nt Happening .i Then Went To Endo. Who Ordered Test And All The Blood Work Was Great.then I Found My Self In Url.getting Scoped.the Whole Thing Freaked Me Out My Endo Told Me To Double My Steriods,in Any Event;i Didnt Know What To Ask The Doc .i'm Sorry Bro But The Word Just Came Down Time To Move The Cars The Storm Looks Bad And I Have To Prepare.wish Us Luck.will

     
    Old 09-12-2004, 08:20 AM   #10
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    Re: advice on conversion Shore if possible?

    Quote:
    Originally Posted by TATS
    Hi, Looks Like The Strom Is Almost Gone?but I Just Heard Ivan The Terrible Is Coming?back To My Question I Take 220mg Of Pain Meds ,ie;roxi Ir,morph.er..........my Liver Is Bad And My Doc Has Advised Me To Go To The Patch.check My Other Thread From Yesterday It May Help Clear Up My Babble?living In Fla .is Hot And I Sweat,plus I Use Hydro Therapy Daily.can The Patch Come Off And Be Put Back On?is It Hard To Work With?i'm Thinking 75 Mg And Loipop For Break Through?this Is Only If Gov.well Take My Civilian Doc Script And Sign Off On It Ie.,agree?the Pharmacy Said They Only Give The Med To Cancer Patients But Would Make The Exception In My Case?this Revolves Around Jansen Pharm Says I Make To Much ,however I'm A Disabled Vet And 550 For A Month Of Patches Is Mind Numbing.no Kidding If The Gov. Does'nt Help It'll Come Down To House, Meds,then Food Or Bills?this Is A Drag And I'm Falling Apart.if Any One Can Give Me Some Direction On The Plus And Minuses Of The Patch That Would Help Me ?am I Going In The Right Direction With All My Other Problems?thanks For Every Thing ...........tats
    They give patches to pain patients too. Hubby and I are both on them. Yes unfortunatly they are very expensive here in Oklahoma they are 400 a box. I'm very thankfull our state medicaid pays for it. As for the patches coming off. It happens either from swimming or bathing or sweating. Yeah it's humid here in Oklahoma. I suggest you get some good alcohol swabs get the big thick good ones and scrub the **** out of where youre gonna put youre patch on clean it till you can't get anymore dirt and oils off. This will ensure a good stick. Mine usually stay on fore the 2 day period but if it should come off, clean and dry that area Scrub it with the alchohol swabbies then reapply the patch with a good medical tape i reccomend getting the widest you can find. That should fix the patch coming off. and the patch is not hard to work with. I apply mine to my shoulders cause thats where i can reach and see. Make sure you put it in an area where youre skin won't bunch up and move around on you. (yeah I'm getting up there in age too LOL I'm getting wrinkles in places i never had any before lol) When you take them off the best way to get the gluey gunky stuff off is to get a good wet alcohol swab and scrub the glue off. Keep in mind to apply a good lotion in those areas as it will dry the skin. PS There are some places that will help you get youre meds. I can't think of any from the top of my head but maybe someone in here can help you.

    Dana

     
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